Differential Diagnosis for Chest Pain 24 hrs after PCI

Single most likely diagnosis

• Stent thrombosis: This is a leading cause of chest pain after a percutaneous coronary intervention (PCI). It occurs when a blood clot forms inside the stent, blocking the artery. The risk is highest in the first 24-48 hours after the procedure.

Other Likely diagnoses

• Myocardial infarction (MI) not related to stent thrombosis: Chest pain could indicate a new blockage in a different part of the coronary artery system.
• Pericarditis: Inflammation of the pericardium, the sac surrounding the heart, can cause chest pain and is a known complication post-PCI.
• Coronary artery dissection: A tear in the inner lining of the coronary artery, which can occur during or after PCI, leading to chest pain.
• Graft occlusion (if patient had previous CABG): If the patient has had a coronary artery bypass graft (CABG) in addition to or before PCI, graft occlusion could cause chest pain.

Do Not Miss (ddxs that may not be likely, but would be deadly if missed)

• Aortic dissection: Although rare, a tear in the aorta's inner layer can be life-threatening and requires immediate attention.
• Pulmonary embolism: A blood clot in the lungs can cause sudden chest pain and is potentially fatal if not treated promptly.
• Cardiac tamponade: Fluid accumulation in the pericardial space can compress the heart, leading to a life-threatening condition.

Rare diagnoses

• Stent malapposition: The stent not being fully expanded or not in contact with the artery wall, which can lead to stent thrombosis but is less common as a direct cause of chest pain.
• Hematoma or pseudoaneurysm at the access site: Complications at the site where the catheter was inserted, which can cause chest pain due to local pressure effects.
• Spontaneous coronary artery dissection (SCAD) not related to PCI: A rare condition where there is a spontaneous tear in the coronary artery, which can cause chest pain and MI.